Orchiectomy

Excerpt

Orchidectomy involves the surgical removal of the testes. It may be a radical or straightforward procedure. Simple orchidectomy is approached through the scrotum and historically has been a significant means of hormonal manipulation in the management of patients with locally advanced prostate cancer. This indication has, over time, been replaced by the less invasive hormonal medications such as gonadotropin-releasing hormone agonists or antagonists. This approach to therapy has limited the indications of simple orchidectomy to the removal of an atrophic testis and non-viable testis due to trauma, torsion, or infection. In contrast, radical orchidectomy uses a through the groin approach. It is the mainstay of diagnosis and treatment of testicular malignancies.

Testicular cancers fall into two main groups; germ cell tumors (GCTs) and non-germ cell tumors. GCTs make up over 95% of testicular tumors, and over 50% of GCTs are seminomas. Non-seminomas comprise a heterogeneous group of tumors with different patterns that may include a combination of histologic types of seminomas and non-seminomas. Non-seminomatous GCTs are almost exclusively associated with elevated tumor markers, while only 10 to 25 percent of seminomas are associated with a rise in beta-human chorionic gonadotropin or lactate dehydrogenase, but no rise in alpha-fetoprotein. Seminomas with elevated serum alpha-fetoprotein are considered to have a component of yolk sac tumors.